Difference In Surgical Complications Research Articles

Magnesium sulfate enhances the effect of the peripheral analgesic cocktail in total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Although magnesium sulfate (MgSO4) is widely used as an analgesic adjuvant to peripheral analgesic cocktails, its efficacy in total knee arthroplasty (TKA) is still controversial. Therefore, we systematically reviewed and meta-analyzed the literature to assess the analgesic efficacy of MgSO4 as an adjuvant to the analgesic cocktail in TKA. The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched. The meta-analysis was performed according to the PRISMA guidelines. Data were qualitatively synthesized or meta-analyzed using a random-effects model. Five randomized controlled trials involving 432 patients were included. Meta-analyses detected significant differences between the MgSO4 and control groups in the visual analog scale (VAS) pain scores (rest) at 6, 12, and 24 h postoperatively; VAS pain scores (motion) at 12, 24, and 48 h postoperatively; morphine consumption within 24 h, 24-48 h, and during the total hospitalization period; time to first rescue analgesia after TKA; and length of hospital stay. Regarding the functional recovery, the meta-analysis demonstrated significant differences between groups in terms of knee range of motion on postoperative day 1; daily mobilization distance on postoperative day 1; and daily mobilization distance. There was no significant intergroup difference in surgical complications. The findings suggest that MgSO4 is a promising adjunct to the analgesic cocktail, achieving significant improvements in pain scores and total opioid consumption during the early postoperative period after TKA.

Image-guided navigation in posterior orbital tumour surgery: a comparative cohort study

ABSTRACT Purpose The posterior orbit is a confined space, harbouring neurovascular structures, frequently distorted by tumours. Image-guided navigation (IGN) has the potential to allow accurate localisation of these lesions and structures, reducing collateral damage whilst achieving surgical objectives. Methods We assessed the feasibility, effectiveness and safety of using an electromagnetic IGN for posterior orbital tumour surgery via a comparative cohort study. Outcomes from cases performed with IGN were compared with a retrospective cohort of similar cases performed without IGN, presenting a descriptive and statistical comparative analysis. Results Both groups were similar in mean age, gender and tumour characteristics. IGN set-up and registration were consistently achieved without significant workflow disruption. In the IGN group, fewer lateral orbitotomies (6.7% IGN, 46% non-IGN), and more transcutaneous lid and transconjunctival incisions (93% IGN, 53% non-IGN) were performed (p = .009). The surgical objective was achieved in 100% of IGN cases, with no need for revision surgery (vs 23% revision surgery in non-IGN, p = .005). There was no statistically significant difference in surgical complications. Conclusion The use of IGN was feasible and integrated into the orbital surgery workflow to achieve surgical objectives more consistently and allowed the use of minimal access approaches. Future multicentre comparative studies are needed to explore the potential of this technology further.

The Utilization of Laparoscopic Ventral Hernia Repair (LVHR) in Incarcerated and Strangulated Cases: A National Trend in Outcomes.

Early after its adoption, minimally invasive surgery had limited usefulness in emergent cases. However, with improvements in equipment, techniques, and skills, laparoscopy in complex and emergency operations expanded substantially. This study aimed to examine the trend of laparoscopy in incarcerated or strangulated ventral hernia repair (VHR) over time. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried for laparoscopic repair of incarcerated and strangulated hernias (LIS-VHR) and compared over 2 time periods, 2014-2016 and 2017-2019. The utilization of laparoscopy in all incarcerated or strangulated VHR increased over time (2014-2016: 39.9% (n = 14 075) vs 2017-2019: 46.3% (n = 18 369), P < .001). Though likely not clinically significant, demographics and comorbidities statistically differed between groups (female: 51.7% vs 50.0%, P = .003; age 54.5 ± 13.7 vs 55.4 ± 13.8years, P < .001; BMI 34.9 ± 8.0 vs 34.6 ± 7.8kg/m2, P < .001). Patients from 2017 to 2019 were less comorbid (18.9% vs 16.8% smokers, P < .001; 18.2% vs 17.3% diabetic, P = .036; 4.6% vs 4.1% COPD, P = .021) but had higher ASA classification (III: 43.3% vs 45.7%; IV: 2.5% vs 2.7%, P < .001). Hernia types (primary, incisional, recurrent) were similar in each group. Operative time (89.7 ± 59.3 vs 97.4 ± 63.4min, P < .001) became longer but length-of-stay (1.4 ± 3.3 vs 1.1 ± 2.6days, P < .001) decreased. There was no statistical difference in surgical complications, medical complications, reoperation, or readmission rates between periods. Laparoscopic VHR has become a routine method for treating incarcerated and strangulated hernias, and its utilization continues to increase over time. Clinical outcomes have remained the same while hospital stays have decreased.

Surgical outcomes of cytoreductive nephrectomy in patients receiving systemic immunotherapy for advanced renal cell carcinoma

PurposeThe use of systemic immune checkpoint blockade before surgery is increasing in patients with metastatic renal cell carcinoma, however, the safety and feasibility of performing consolidative cytoreductive nephrectomy after the administration of systemic therapy are not well described. Patients and MethodsA retrospective review of patients undergoing nephrectomy was performed using our prospectively maintained institutional database. Patients who received preoperative systemic immunotherapy were identified, and the risk of postoperative complications were compared to those who underwent surgery without upfront systemic treatment. Perioperative characteristics and surgical complications within 90 days following surgery were recorded. ResultsOverall, we identified 220 patients who underwent cytoreductive nephrectomy from April 2015 to December 2022, of which 46 patients (21%) received systemic therapy before undergoing surgery. Unadjusted rates of surgical complications included 20% (n = 35) in patients who did not receive upfront systemic therapy and 20% (n = 9) in those who received upfront systemic immunotherapy. In our propensity score analysis, there was no statistically significant association between receipt of upfront immunotherapy and 90-day surgical complications [odds ratio (OR): 1.82, 95% confidence interval (CI): 0.59–5.14; P = 0.3]. This model, however, demonstrated an association between receipt of upfront immunotherapy and an increased odds of requiring a blood transfusion [OR: 4.53, 95% CI: 1.83–11.7; P = 0.001]. ConclusionIn our cohort, there was no significant difference in surgical complications among patients who received systemic therapy before surgery compared to those who did not receive upfront systemic therapy. Cytoreductive nephrectomy is safe and with low rates of complications following the use of systemic therapy.

Patient’s Perception Regarding Vision Related Quality of Life in Immediate Sequential and Delayed Sequential Bilateral Cataract Surgery

Cataract is the main cause of visual impairment and treatable blindness in the world and surgery can restore normal sight to the patients. In bilateral cataract patient, surgery in the second eye is as important and meaningful as surgery in the first eye and it can be performed by immediate sequential (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS). There is no statistically significant difference in surgical complications, visual acuity or long term self-perceived visual function between these two methods. To adopt surgical procedure, to improve the patient’s satisfaction and to improve the quality of services, patient opinion should be a great concern. This evaluative study was done to find out various recommendations and suggestions from patients regarding merits &amp; demerits of both types of cataract surgery that will be helpful for the decision-maker and administrator for future practice of cataract surgery in Canada. In this study, vision related quality of life improved in both groups. Participants in DSBCS group experienced different types of difficulties during the gap period between first eye and second eye cataract surgery i.e. visual imbalance between the two eyes and difficulty in driving. They recommended and suggested that cataract surgery wait time should be reduced and the difficulties experienced during the gap period can be eliminated by adopting ISBCS procedure. Bangabandhu Sheikh Mujib Med. Coll. J. 2023;2(1): 07-13

Parathyroidectomy outcomes for Asians in the United States: Implications for resident surgical education

IntroductionOutcomes for Asian patients in the United States are often overlooked in the surgical literature. Surgical education includes little emphasis on reporting outcomes for Asian patients in the United States. Our null hypothesis (H0) is that there is no difference in surgical complications following parathyroid surgery between Asians and all other ethnicities in the United States. Our alternate hypothesis (H1) is that Asians have more incidences of certain complications (possibly due to culture and language barriers). MethodsData from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was queried for parathyroidectomy and patient race. Complications within 30 days of surgery were extracted. ResultsAmong, White, Black, Asian, Pacific Islanders, Native Americans, and Hispanic patients of the United States the Asians (p = 0.018) and Blacks (p = 0.003) had increased operative time for parathyroid surgery compared to other groups. Hispanics had the most surgical complications (p = 0.025). Blacks had statistically significant longer hospital stay (p < 0.0001). Discussion/conclusionUnited States Asian patient data is not typically analyzed separately for complications. We found that in the United States Asians have increased operative time for parathyroidectomy. Future studies of healthcare inequities should include analysis of data for Asian surgical data in the United States as this may help prevent future surgical complications.

Obesity does not associate with 5-year surgical complications following anatomic total shoulder arthroplasty and reverse total shoulder arthroplasty.

Although obesity has been shown to increase the risk of short-term medical complications following total shoulder arthroplasty (TSA), evidence is lacking on the influence of obesity on longer-term surgical complications such as revision. The purpose of this study was to assess the association of increasing obesity with 2- and 5-year all-cause revision, periprosthetic joint infection (PJI), aseptic loosening, and manipulation under anesthesia (MUA) among patients undergoing reverse total shoulder arthroplasty (RTSA) or TSA. Patients who underwent RTSA or TSA with a minimum 5-year follow-up were identified in a national claims database (PearlDiver Technologies). Patients with obesity (body mass index [BMI]≥30) were compared to patients who are normal or overweight (18.5 ≤ BMI < 30). Those with obesity were further stratified to those with class I or II obesity (30 ≤ BMI < 40) and those with class III obesity (BMI ≥ 40). Outcomes for comparison included all-cause revision, PJI, aseptic loosening, and MUA within 2 or 5 years. These cohorts were compared using univariate and multivariable analysis. Patients with obesity had no significant difference in any surgical complication within 2 or 5 years for both those who underwent TSA or RTSA. After stratifying by class I or II obesity and class III obesity, there was still no significant difference in surgical complications with 2 or 5 years for both TSA patients and RTSA patients. Obesity, when other major comorbidities are controlled for, was not associated with increased risk of long-term surgical complications after shoulder replacement surgery.

A comparative study for the efficacies of transaxillary non-inflatable endoscopic surgery versus traditional surgery for papillary thyroid carcinoma

Objective: To compare the efficacies between open surgery and axillary non-inflatable endoscopic surgery in papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was performed on 343 patients with unilateral PTC treated by traditional open surgery (201 cases) and transaxillary non-inflating endoscopic surgery (142 cases) from May 2019 to December 2021 in the Head and Neck Surgery of Sichuan Cancer Hospital. Among them, 97 were males and 246 were females, aged 20-69 years. 1∶1 propensity score matching (PSM) was performed on the enrolled patients, and the basic characteristics, perioperative clinical outcomes, postoperative complications, postoperative quality of life (Thyroid Cancer-Specific Quality of Life), aesthetic satisfaction and other aspects of the two groups were compared after successful matching. SPSS 26.0 software was used for statistical analysis. Results: A total of 190 patients were enrolled after PSM, with 95 cases in open group and 95 cases in endoscopic group. Intraoperative blood losses for endoscopic and open groups were [20 (20) ml vs. 20 (10) ml, M (IQR), Z=-2.22], postoperative drainage volumes [170 (70)ml vs. 101 (55)ml, Z=-7.91], operative time [135 (35)min vs. 95 (35)min, Z=-7.34], hospitalization cost [(28 188.7±2 765.1)yuan vs. (25 643.5±2 610.7)yuan, x¯±s, t=0.73], postoperative hospitalization time [(3.1±0.9)days vs. (2.6±0.9)days, t=-3.24], and drainage tube placement time [(2.5±0.8) days vs. (2.0±1.0)days, t=-4.16], with statistically significant differrences (all P<0.05). There was no significant difference in surgical complications (P>0.05). There were significant diffferences between two groups in the postoperative quality of life scores in neuromuscular, psychological, scar and cold sensation (all P<0.05), while there were no statistically significant differences in other quality of life scores (all P>0.05). In terms of aesthetic satisfaction 6 months after surgery, the endoscopic group was better than the open group, with statistically significant difference (χ2=41.47, P<0.05). Conclusion: Endoscopic thyroidectomy by a gasless unilateral axillary approach is a safe and reliable surgical method, which has remarkable cosmetic effect and can improve the postoperative quality of life of patients compared with the traditional thyroidectomy.

MP31-08 KIDNEY TRANSPLANTATION FROM DONATION AFTER BRAIN DEATH VERSUS DONATION AFTER CIRCULATORY DEATH USING ABDOMINAL NORMOTHERMIC OXYGENATED CIRCULATION IS THERE A DIFFERENCE IN SURGICAL COMPLICATIONS?

You have accessJournal of UrologyCME1 Apr 2023MP31-08 KIDNEY TRANSPLANTATION FROM DONATION AFTER BRAIN DEATH VERSUS DONATION AFTER CIRCULATORY DEATH USING ABDOMINAL NORMOTHERMIC OXYGENATED CIRCULATION IS THERE A DIFFERENCE IN SURGICAL COMPLICATIONS? Alberto Costa Silva, Teresa Pina-Vaz, Margarida Manso, Tiago Antunes-Lopes, Afonso Morgado, Carlos Martins-Silva, and João Alturas-Silva Alberto Costa SilvaAlberto Costa Silva More articles by this author , Teresa Pina-VazTeresa Pina-Vaz More articles by this author , Margarida MansoMargarida Manso More articles by this author , Tiago Antunes-LopesTiago Antunes-Lopes More articles by this author , Afonso MorgadoAfonso Morgado More articles by this author , Carlos Martins-SilvaCarlos Martins-Silva More articles by this author , and João Alturas-SilvaJoão Alturas-Silva More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003264.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Donation after circulatory death (DCD) is being considered a reliable source of kidneys given the scarcity of donation after brain death with standard- (DBD/SCD) and expanded-criteria (DBD/ECD). Our center has started a transplantation program for uncontrolled DCD donors after unsuccessful resuscitation (Maastricht II donors) using extracorporeal normothermic membrane oxygenation (ECMO). Our objective was to compare the surgical complications of kidney transplants from DCD/ECMO versus donation after DBD with SCD and ECD. METHODS: From January 2016 to October 2021, a prospective study was performed and three groups were considered – DCD/ECMO, DBD/SCD and DBD/ECD. Demographic data from donors and recipients were collected. Graft function evolution was assessed using creatine and glomerular filtration rate. Delayed graft function (DGF) was defined as the need for dialysis in the first week after transplantation. Surgical complications were classified as arterial, venous, ureteral, lymphatic, suture dehiscence, and/or need for early graft removal (defined as removal in the first 3 months after transplantation). The cause of early graft removal was noted and categorized as either a surgical or non-surgical complication. RESULTS: A total of 100 kidneys were implanted from DCD/ECMO, 108 from DBD/SCD and 115 from DBD/ECD.Despite a higher rate of DGF in DCD/ECMO groups vs DBD/SCD and DBD/EDC (65,9% vs 28,1% vs 30,8%; p<0,001), there were no differences in renal function between groups 12 months after transplantation. There were no statistically significant differences in surgical complications. Early graft removal was lower in DBD-SCD group. DCD/ECMO group had a significantly more early graft removals of non-surgical cause due to tubular necrosis, humoral rejection or infection, while DBD/ECD had a significantly more early graft removals of surgical cause due to arterial/venous thrombosis and hemorrhage. CONCLUSIONS: Kidney transplantation from DCD/ECMO can be a viable option. Despite higher rates of DGF in DCD/ECMO, those whose grafts survive have a similar renal function in the medium-to-long term. Early graft removal was mainly associated with a non-surgical cause, probably related to ischemia lesion caused by prolonged warm ischemia time and/or ischemia-reperfusion injury induced by the ECMO. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e432 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alberto Costa Silva More articles by this author Teresa Pina-Vaz More articles by this author Margarida Manso More articles by this author Tiago Antunes-Lopes More articles by this author Afonso Morgado More articles by this author Carlos Martins-Silva More articles by this author João Alturas-Silva More articles by this author Expand All Advertisement PDF downloadLoading ...

Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery.

Tranexamic acid for the reduction of bleeding during functional endoscopic sinus surgery.

Kidney transplantation from donation after brain death versus donation after circulatory death using abdominal normothermic oxygenated circulation: Is there a difference in surgical complications?

Kidney transplantation from donation after brain death versus donation after circulatory death using abdominal normothermic oxygenated circulation: Is there a difference in surgical complications?

Surgical Outcomes between Routes of Hysterectomy in Patients with a Previous Cesarean Section

To determine the difference in surgical complications for patients with a prior cesarean section (CS) undergoing abdominal, vaginal or laparoscopic hysterectomy. A population based retrospective cohort study. Province of Ontario, Canada. 10 300 patients with at least 1 CS between July 1, 1991 and February 17, 2018. Benign, non-gravid hysterectomy between Apr 1, 2002 and March 31, 2018. The primary outcome was a composite of all surgical complications within 30 days of surgery. Secondary outcomes were rate of genitourinary complications, readmission to hospital and emergency department visit occurring within 30 days of surgery. Of 10,300 patients who had at least one previous CS, who underwent subsequent hysterectomy for a benign indication, 7370 underwent an abdominal hysterectomy (71.55%), 813 (7.9%) had a vaginal hysterectomy and 2117 (20.55%) underwent a laparoscopic hysterectomy. The adjusted odds of any surgical complication from hysterectomy was significantly lower when performed by the vaginal approach compared to the laparoscopic approach (OR 0.32 95% CI 0.20-0.51 p<0.0001). There was no difference in the odds of surgical complication between abdominal and laparoscopic approaches (OR 1.09 95% CI 0.87-1.37, p=0.45). Our retrospective population-based study demonstrates that after previous cesarean section, patients selected to undergo vaginal hysterectomy, experienced lower risk than either abdominal or laparoscopic approaches. This suggests that cesarean section alone should not be a contraindication to vaginal hysterectomy.

Postoperative Restrictive Opioid Protocols and Durable Changes in Opioid Prescribing and Chronic Opioid Use

Changes in postsurgical opioid prescribing practices may help reduce chronic opioid use in surgical patients. To investigate whether postsurgical acute pain across different surgical subspecialties can be managed effectively after hospital discharge with an opioid supply of 3 or fewer days and whether this reduction in prescribed opioids is associated with reduced new, persistent opioid use. In this prospective cohort study with a case-control design, a restrictive opioid prescription protocol (ROPP) specifying an opioid supply of 3 or fewer days after discharge from surgery along with standardized patient education was implemented across all surgical services at a tertiary-care comprehensive cancer center. Participants were all patients who underwent surgery from August 1, 2018, to July 31, 2019. Main outcomes were the rate of compliance with the ROPP in each surgical service, the mean number of prescription days and refill requests, type of opioid prescribed, and rate of conversion to chronic opioid use determined via a state-run opioid prescription program. Postsurgical complications were also measured. A total of 4068 patients (mean [SD] age, 61.0 [13.8] years; 2528 women [62.1%]) were included, with 2017 in the pre-ROPP group (August 1, 2018, to January 31, 2019) and 2051 in the post-ROPP group (February 1, 2019, to July 31, 2019). The rate of compliance with the protocol was 95%. After implementation of the ROPP, mean opioid prescription days decreased from a mean (SD) of 3.9 (4.5) days in the pre-ROPP group to 1.9 (3.6) days in the post-ROPP group (P < .001). The ROPP implementation led to a 45% decrease in prescribed opioids after surgery (mean [SD], 157.22 [338.06] mean morphine milligram equivalents [MME] before ROPP vs 83.54 [395.70] MME after ROPP; P < .001). Patients in the post-ROPP cohort requested fewer refills (367 of 2051 [17.9%] vs 422 of 2017 [20.9%] in the pre-ROPP cohort; P = .02). There was no statistically significant difference in surgical complications. The conversion rate to chronic opioid use decreased following ROPP implementation among both opioid-naive patients with cancer (11.3% [143 of 1267] to 4.5% [118 of 2645]; P < .001) and those without cancer (6.1% [19 of 310] to 2.7% [16 of 600]; P = .02). In this cohort study, prescribing an opioid supply of 3 or fewer days to surgical patients after hospital discharge was feasible for most patients, led to a significant decrease in the number of opioids prescribed after surgery, and was associated with a significantly decreased conversion to long-term opioid use without concomitant increases in refill requests or significant compromises in surgical recovery.

Preoperative chemoradiotherapy with capecitabine and triweekly oxaliplatin versus capecitabine monotherapy for locally advanced rectal cancer: a propensity-score matched study

BackgroundDistant metastasis has been the main failure pattern for locoregionally advanced rectal cancer (LARC) patients, and intensified neoadjuvant chemotherapy has become a popular research topic. The present study aimed to compare the survival outcomes, acute toxicities and surgical complications in LARC patients who received preoperative chemoradiotherapy with triweekly oxaliplatin and capecitabine (triweekly XELOX) or capecitabine.Methods: Between 2007 and 2017, patients with clinically staged II-III rectal cancer who were treated with preoperative chemoradiotherapy using either triweekly XELOX (oxaliplatin 130 mg/m2 plus capecitabine 825 mg/m2) or capecitabine were included. Variables potentially influencing chemotherapy treatment selection were used to generate propensity scores (PS). The association between chemotherapy regimens and survival endpoints, including distant metastasis-free survival (DMFS), overall survival (OS) and disease-free survival (DFS), were evaluated and adjusted with PS. The acute toxicities and surgical complications were also compared.ResultsA total of 810 patients were included in the analysis; 277 (34.2%) patients received triweekly XELOX, and 533 (65.8%) received capecitabine. The pathological complete response (pCR) rates were 20.2 and 19.9% (P = 0.912) for the groups treated with triweekly XELOX and capecitabine, respectively. The 5-year DMFS, OS and DFS with triweekly XELOX versus capecitabine were 75.6% vs. 77.6% (P = 0.555), 79.2% vs. 83.3% (P = 0.101), and 69.9% vs. 73.7% (P = 0.283), respectively. Triweekly XELOX was not associated with an increased risk of severe toxicity during chemoradiotherapy, but it increased the risk of postoperative complications compared to capecitabine. After PS adjustment, the differences between the two groups remained insignificant in pCR rate, survival outcomes, and acute toxicities, and the difference in surgical complications disappeared.ConclusionsTriweekly XELOX or capecitabine concurrent with neoadjuvant radiotherapy leads to similar long-term survival outcomes, acute toxicities and surgical complications in LARC patients.

Impact of Age and Frailty on Short-Term Postoperative Outcomes after Hepatectomy: Analysis from a Tertiary UK Centre

Background: Elderly patients are increasingly considered for major surgery, including hepatectomy, and are at risk of postoperative morbidity. Although fitness assessment prior to hepatectomy is standard, there is limited data on the impact of frailty. The aim of this study was to determine the incidence and outcomes of frailty in patients undergoing hepatectomy. Patients and Methods: Consecutive patients who underwent hepatectomy between 2011-2019 were identified from a prospective database. Perioperative variables were obtained and frailty was determined with the modified Frailty Index (mFI). Patients aged ³75 years were considered elderly. The impact of age and frailty on outcomes were compared by univariable analysis. Results: Of 1851 patients, 341 (18.4%) were elderly and 642 (34.7%) were frail (mFI³1). A significantly higher proportion of elderly patients were frail compared to non-elderly patients (52.4% v. 30.7%; p<0.001). The proportions of patients undergoing major hepatectomy were similar irrespective of age (³75 v <75: 42.2% v 46.8%; p=0.092) or frailty (mFI³1 v mFI=0: 42.2% v. 46.2%; p=0.363). Medical complications were significantly more likely in elderly (24.9% v. 16.6%; p<0.001) and frail patients (23.5% v. 15.2%; p<0.001), but there was no difference in surgical complications in either group. 90-day mortality was significantly higher in elderly (6.7% v. 3.6%; p=0.016) and frail patients (6.5% v. 2.9%; p<0.001). Conclusion: In carefully selected patients, acceptable morbidity and mortality rates can be achieved for elderly or frail patients undergoing hepatectomy. Elderly patients are at particular risk of medical complications and are likely to benefit from frailty assessment and prehabilitation.

Safety of the “incidental” neck dissection or exploration during free tissue transfer after head and neck irradiation

ImportancePatients with either local recurrence of head and neck cancer or osteoradionecrosis after prior radiation treatment often require free tissue transfer for optimal reconstruction. In this setting, neck exploration for vessels is necessary, and an “incidental” neck dissection is often accomplished despite clinically negative cervical lymph nodes. While neck surgery in the post-radiated setting is technically challenging, the safety of post-radiated elective neck dissection or neck exploration for vessels is not well-studied, especially for patients undergoing non-laryngectomy salvage resections. ObjectiveTo define intraoperative and postoperative surgical complications for patients undergoing elective neck dissection or exploration with free tissue transfer reconstruction in the post-radiated setting, with attention to complications from neck surgery. DesignRetrospective cohort study. Patient charts from May 2005 to April 2020 were reviewed. SettingTertiary care referral center. ParticipantsPatients underwent free tissue transfer after prior head and neck irradiation for non-laryngeal local cancer recurrence or second primary, osteoradionecrosis, or for sole reconstructive purposes. Patients with clinically positive neck disease were excluded. Main outcomes and measuresIntraoperative and postoperative complications including unplanned vessel or nerve injury, hematoma, chyle leak, wound dehiscence, wound infection, fistula formation, flap failure, and perioperative medical complications. Neck exploration and neck dissection patient outcomes were compared by Fisher exact test. ResultsSeventy-two patients (56 men and 16 women) of average age sixty-one (range 34–89) were identified with average follow-up 25.7 months. Most patients (78%) underwent salvage neck dissection, and the rest underwent neck exploration for vessels only. There were five intraoperative neck complications: three vessel injuries and two nerve injuries. There were twenty-six postoperative surgical complications among eighteen patients. There was no difference in surgical complications whether patients underwent neck dissection or exploration only. Two partial and two complete flap failures occurred. There were nine perioperative medical complications among six patients. Conclusions and relevanceElective neck dissection or exploration among patients undergoing free tissue transfer in the post-radiated setting carries a risk of both intraoperative and postoperative surgical complications. The present study defines risk of complications and helps to inform patient discussions for risk of complications in the post-radiated setting.

Clinical Outcome of Primary Total Hip Arthroplasty in Patients with Morbid Obesity-Retrospective and Prospective Follow-Up Studies.

Background and objective: There is a general clinical concern on the negative impact of obesity on surgical complications and functional outcomes. We hypothesized that the patients with morbid obesity are exceptionally prone to a significantly increased risk for surgical and short-term complications after primary total hip arthroplasty (THA). We aimed to identify the range of Body Mass Index (BMI) values of patients with a significant risk for lower functional improvement after THA. Materials and methods: In Stage 1 of the study, we conducted a retrospective comparative analysis of the rate of complications and functional outcomes in patients treated by primary THA, with normal weight (BMI 19–25, N = 1205) vs. Class 1 (BMI 26–34, N = 450), Class 2 (BMI 35–39, N = 183), and Class 3 (BMI ≥ 40, N = 47) obese patients. After the statistical similarity rates of complications and 6- and 12-month functional outcomes (by Harris Hip and SF-36 scores) were revealed in Class 1 patients and patients with normal BMI, we conducted the Stage 2 prospective study, by the same comparison protocol, on the cohorts of Class 2 (N = 29) and Class 3 (N = 16) patients compared to the Class 1 patients (N = 37) as controls. Results: Stage 1: There was no difference in surgical complications and function on 6- and 12-month postoperative follow-up (physical and mental) between Class 1 and patients with normal BMI (p > 0.05). Surgical complications were significantly higher in Class 2 (p < 0.05) and Class 3 (p < 0.001) patients. Functional activity on the 12-month follow-up increased significantly in all study groups, but in the Class 3 patients, the functional parameters were significantly lower (0.001). The mental health status on the follow-up was similar in all study groups. Stage 2 study revealed similar to the retrospective study comparison of parameters, except for the significantly lower mental health scores in Class 2 and Class 3 patients (p < 0.05) and functional scores in Class 3 patients (p < 0.05). Conclusion: Although the functional ability increased in all patients, it was significantly lower in Class 3 patients (with morbid obesity). Therefore, the patients with Class 1 and Class 2 obesity should be conceptionally distinguished from Class 3 patients in the decision-making process for a primary THA because of the less favorable functional and mental health improvement in those with morbid obesity (Class 3).

Sex-related differences in stemless total shoulder arthroplasty.

BackgroundThe use of stemless humeral implants for shoulder arthroplasty is becoming increasingly widespread. However, little is known about the difference in clinical, functional, and radiographic outcomes of stemless shoulder arthroplasty between men and women. Men and women do have reported differences in size, strength, and bone quality. As such, the purpose of this study was to evaluate sex-related differences in outcomes when using stemless humeral implants.MethodsA retrospective review of 227 patients (men = 143 and women = 84) undergoing stemless shoulder arthroplasty was compared for sex-related differences. Clinical, functional, and radiographic outcomes were compared, including American Shoulder and Elbow Surgeons (ASES) scores, visual analog scale pain scores, range of motion, radiolucencies, operative data, implant data, and complications. Statistical analysis included descriptive statistics, t-tests, chi-square tests, and logistic regression.ResultsPreoperatively, men had a statistically significant greater range of motion of forward elevation (P < .01), external rotation (ER) at adduction (P = .04), ER at 90° abduction (P = .03), and baseline ASES scores (P < .01). At 2 years, there were no differences between men and women in ASES score (P = .12), visual analog scale pain score (P = .74), active ER (P = .98), implant migration, or radiolucencies (P > .99). Mean operating time was 9 minutes longer in male patients (P < .01). There was no significant difference in surgical complications, including dislocation, fracture, infection, or loosening. The three-year revision-free survival was 98.8% for women and 97.9% for men.ConclusionPatient sex is not predictive of postoperative functional outcomes after stemless shoulder arthroplasty. The operative time was significantly shorter in female patients, and there was no significant difference in surgical complications between men and women.

Early Results in Non-Displaced Femoral Neck Fractures Using the Femoral Neck System.

IntroductionFemoral neck fractures in the elderly are a major event and are rising in incidence over the last decade. Advancing age and numerous comorbidities largely account for high mortality rate and require geriatric expertise. Treatment options are total hip arthroplasty (THA), hemiarthroplasty (HA) or osteosynthesis. Literature suggests THA or HA for better outcomes, although no clear guidelines exist.Material and methodsA retrospective chart review was performed of 63 patients (80 ± 11 years; 32 women, 31 men) with Garden one femoral neck fractures treated between June 2018 and June 2020 with either HA or internal fixation with the Femoral Neck System (FNS). Primary outcome measures were surgical and non-surgical complication rates and best achievable mobilization during the hospital stay.ResultsThirty four patients were treated with HA, and 29 with the FNS. Mobilization was measured using the Charité Mobility Index (CHARMI). No difference between age, ASA, CCI or preoperative CHARMI was found. The CHARMI was significantly lower in the HA group. No difference in surgical complications was found. The HA cohort showed more non-surgical complications, a longer ICU stay and more blood transfusions. Hospitalization was significant longer in the HA than the FNS cohort (15.1 ± 5.1 vs 9.8 ± 3.8 days). Radiographic controls were performed after 6 and 12 weeks. The FNS group showed a mean shortening of 3.3 mm. 4 of 21 patient had shortening >5 mm. 20 of 21 patients showed radiographic signs of bone healing after 3 months.ConclusionEarly results with the FNS show faster recovery than patient with hemiarthroplasty. Internal fixation with the FNS may be an option in non-displaced femoral neck fractures. Further studies should be performed to better evaluate the FNS compared to traditional internal fixation methods and arthroplasty.

A Comparison of Surgical Outcomes between the Routes of Benign Hysterectomy in Women with at Least One Previous Cesarean Section

Study Objective To determine the difference in surgical complications for women with a prior cesarean section (CS) undergoing abdominal (AH), vaginal (VH) or laparoscopic (LH) hysterectomy. Design A population based retrospective cohort study. Setting Ontario, Canada. Patients or Participants This study included 71,599 women in Ontario, Canada with at least 1 delivery between July 1, 1991 and February 17, 2018 who subsequently underwent benign, non-gravid hysterectomy between April 1, 2002 and March 31, 2018. Interventions At least one CS delivery. Measurements and Main Results Of the 71,599 patients who met the study criteria, 10,300 (14.3%) had at least one previous CS. Among women with no previous CS, the incidence of AH, VH and LH was 53.6%, 24.1% and 22.3% respectively. For women with a previous CS, the respective incidences of hysterectomy were 71.6%, 7.9% and 20.6%. Compared with women who had only vaginal deliveries, multivariable analysis showed that previous CS significantly increased the odds of the primary outcome, any surgical complication 30 days from hysterectomy (OR=2.2 95% CI 2.02-2.4, p Conclusion This study demonstrates that a history of CS increases the risk of any surgical complication from a subsequent hysterectomy regardless of surgical approach. Contrary to traditional teaching, acknowledging the limitations of this retrospective study, it also suggests that VH may be associated with less risk than either abdominal or laparoscopic approaches even in the setting of a previous CS.